Allure of Nevada May Also Be Making Residents Sick : Lifestyle: Some say gaming industry and disdain for advice lead state to be among most unhealthful in U.S.

Laissez faire is the law of this land. You can roll the dice until dawn, gulping complimentary Bloody Marys as you go. You can hire a prostitute for a day, and not fret about undercover cops. It is all legal here in the Silver State, and the locals like it that way.

But now Nevadans are finding that their indulgent lifestyle comes at a price--the public health. Nevada is among the sickest states in the union, ranking poorly in everything from the incidence of lung and liver disease to the high rate of cancer deaths and new AIDS cases.

Nevadans are more likely than other Americans to die in the workplace or in automobile accidents, and the state’s suicide rate is twice the national average. In one study blending these and other findings, Nevada ranked worse in overall healthiness than all but four of the 50 states.

There is a wrinkle in this picture that is troubling for an image-conscious place: The very temptations that lure people to Nevada may be spawning many of the health problems suffered by its mushrooming population.

The all-important gaming industry encourages a lifestyle of excessive drinking, smoking and other habits linked with illness, experts say. Nevada’s health advocates try mightily to counter this influence with messages about the perils of smoking and the benefits of a low-fat diet, but their advice is hard to hear. It is drowned out by the gambling pitchmen.

“The trouble is the casinos create this 24-hour party lifestyle, and there are a lot of very unhealthy behaviors that go along with it,” said Diane Armstrong, president of the Nevada Public Health Assn. “It’s very hard to fight that. It’s pervasive and powerful. . . . It’s just the way things are in this state.”

There is another force at work, Armstrong and others say--the public’s overwhelming disdain for government meddling. Descendants of settlers who survived harsh temperatures and other hazards to tame the rugged territory, Nevadans are an independent and self-sufficient group. They have little use for those who would tell them how to live.

Just ask Bud Uphoff, a plain-spoken recovering alcoholic who moved to Las Vegas from a tiny town in Texas almost 30 years ago.

“People here don’t appreciate a bunch of experts preaching about how everybody should stop drinking and partying and clean up their act,” said Uphoff, who has been a bellman at the Stardust Hotel for 27 years.

After pausing to revisit his cigarette, he continued: “This is a place where you make your own decisions and nobody bothers you. That’s one reason a lot of people come here. That’s one reason it’s a good place for me.”

Dr. Donald Kwalick, Nevada’s chief health officer, said Uphoff speaks a gospel embraced by many residents. Asked about the challenge this creates for people in his line of work, Kwalick said: “Changing attitudes about health and lifestyles is a very tough sell in this state.”

Exacerbating the frustrations of experts such as Kwalick is the situation next door in Utah. Although similar to Nevada in demographics, climate and size, Utah sits at the opposite end of the sickness spectrum. Last year, it was ranked the third-healthiest state in the United States in a national insurance company study, behind Hawaii (No. 1) and Nebraska (No. 2).

“The contrast is dramatic,” said Larry Matheis, executive director of the Nevada State Medical Assn., “and the main difference is lifestyle.” He said Nevadans rank first in the nation for the prevalence of smoking, while Utah is last. The standings are similar for alcohol consumption.

“People in Utah are making good decisions about healthy behavior,” said David Ordos, manager of research for Northwestern National Life Insurance Co., which annually ranks states’ healthiness based on 17 measures. “In Nevada, people are making lifestyle choices that clearly carry risks.”

One explanation for Utah’s performance, Ordos and others say, is the influence of the Church of Jesus Christ of Latter-day Saints, which discourages alcohol and tobacco use and counts about 65% of the state’s residents as members. But another factor may be Utah’s aggressive advocacy of healthy living.

Beginning in kindergarten, Utah residents are fed a barrage of information by the state Bureau of Health Promotion and Risk Reduction, which has been touting disease prevention for 13 years. Utah was one of the first states to adopt restrictions on smoking in public places--in 1976--and was the first to pass a law forbidding prisoners to light up.

“Utah has paid attention to public health for a long time,” said the bureau’s director, Gary Edwards.

This has not been the case in Nevada. Health officials here say their sparsely populated state missed out on the 1960s and early ‘70s boom in federal public health initiatives, which created programs for everything from prenatal care to disease screening.

Consequently, “the infrastructure for providing a lot of basic, preventive health care services was never built in Nevada,” said Matheis, the former director of the state’s health department.

As for the state Legislature, it historically has not made public health a priority, critics charge. “We’ve gotten lip service from them, but no action,” said Armstrong of the public health association.

Meanwhile, the state’s leading industry and largest employer--gaming--serves up an open-ended invitation to forget prudence and indulge. When the drinks are free and you can make $20 last all night at the blackjack table, why do anything else?

Deborah Kist, a bartender at the Frontier Hotel on the Vegas Strip, knows well the dangers of her town. “You’ve got to keep your head on straight, or this place will get you,” said Kist, a recovering alcoholic. “I’ve seen it happen to so many people. You can drink for free and get whatever else you want here. It’s great, but only if you keep your wits about you.”

The most vulnerable Nevadans are those like Kist, those who make the gaming industry run--the casino employees. Working in a stressful round-the-clock subculture characterized by failed marriages, relatively low wages and the constant pressure to party, many pay little attention to health. Others lack insurance coverage.

“Basically, they tend to be sicker when they finally do come in for care,” said Lynn Atcheson of Washoe Medical Center in Reno. “Many people wind up in emergency rooms for problems that get out of hand.”

So hospital stays are longer and health care costs--which in Nevada are among the highest in the nation--go up, Atcheson said.

Health officials also fault the gaming industry in another respect--for its opposition to anti-smoking legislation. While many casinos offer nonsmoking tables and smoke-free showrooms, they were exempted from the state’s first smoking restrictions, adopted last year. “In a way, we (health advocates) are like David taking on Goliath,” said Dr. Heather Allen, a Las Vegas oncologist. “We’re up against some sacred, longstanding traditions.”

Gradually, however, change is coming.

At Harrah’s casino in Reno, workers are treated to on-site health fairs offering cholesterol screening, body fat analysis, flu shots and other services. The casino pays for nicotine patches and other measures to help its employees quit smoking, and also covers weight-loss programs.

Jan Ellison, manager of benefits for Harrah’s, said employees also have an economic incentive to drop unhealthy habits: Those who are overweight or smoke pay more for their health coverage.

State health officials, meanwhile, have launched an ambitious effort to prioritize Nevada’s health care needs and set goals. Although he is limited by the state’s budget crunch, Kwalick dreams of a wellness program in grade schools--a high-profile splash to “convince Nevadans to take responsibility for their health from an early age.”

“It is not pleasant being known as a state with a poor record on health,” Kwalick said. “We need to make people pay attention to their lifestyle and turn things around.”

Most health officials are on the bandwagon, but at least one is somewhat more sanguine. Dr. Otto Ravenholt has been the top health officer for Clark County, home of Las Vegas, for almost three decades. He has come to appreciate that Nevadans like to do things their way, at their own pace. These days he wonders how far the state should go in pressuring people to change their lifestyles.

“I think we have to be careful not to be too relentless about this approach, and I’m not in favor of Draconian measures,” said Ravenholt. “I’m not disappointed with the Nevada life pattern. People have a right to make their own choices, so long as they don’t unduly harm others. What is so wrong with that?”